Professional Documents
Culture Documents
Background
Monroe Memorial Hospital (MMH) is a 300 bed community hospital in a relatively affluent and technically savvy community which provides the usual range of medical inpatient and outpatient services in the Chicago suburbs. MMH also has an affiliated outpatient facility for acute care and treatment.
Plan Outline
Guiding Principles Project Objectives Steering Committee Roles and Responsibilities Project Implementation Committee Roles and Responsibilities Communication Responsibilities & Tasks Architecture Inventory Input Device Analysis Project Budget & ROI
Guiding Principles
Engage Stakeholders Plan for Interoperability Requirements Patient Centered Focus Manage for Accountability Systems Coding & Classification Integration Design analysis Functions Workflow analysis Business process analysis Strategic alignment User requirement specifications HIPAA, Joint Commission, OIG
Approach
Project Objectives
Implement and improve MMHs health information system towards a comprehensive electronic medical record accessible at any point of clinical decision-making
Improve clinical quality and process efficiency through an effective implementation of Computerized Physician Order Entry and Clinical Decision Support Leverage technology to advance strategic health care goals and support priority clinical areas of emphasis Move from standalone, independent systems to a more integrated suite of related business, financial, and clinical systems
Project Leader/Manager System Champions Medical Directors Nursing Directors IT Director Finance Director Operations Directors Key individuals from Clinical and Administrative Departments
CMO CNO CFO COO CIO Vendor representatives Project manager System trainer IT Systems Administrator
Project Organization
Major Milestones
Project Charter
Budget Development Implementation Plan Workflow Assessment/Reengineering Data Conversion User Acceptance Testing Training
Deployment of System
Implementation Assessment
Systems Inventory
Some space issues can be overcome by: Computers on wheels (COWs) Suspended/flat panel monitors Special trays for keyboards
Mobility Affords continuous log-on More like pen and paper Requires wireless network or docking stations life issue High cost Not all electronic medical records (EMRs) are designed to work optimally on a tablet
Lower cost Laptop/Notebook PCs Laptop/Notebook PCs may substitute for desktop PCs, especially when some degree of mobility is desired, or when affixed to carts (COWs). When used as a desktop, they take on the characteristics of desktops. Laptop/Notebook PCs also come with tablets (called convertibles). When used as a tablet, they take on the characteristics of a tablet. In general, laptops/notebooks are more expensive than desktops and somewhat more expensive than a slate-type tablet.
Timeline Overview
Tasks Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012
Create Training Budget Implementation Communications System customization and testing Work flow Assessment
Workflow redesign
Creation of workflow reference tools per Department
Create Disaster Recovery Protocols Update policy and procedure manuals Distribute P&P manuals and collect old Create Training Schedules Design Training Format
Training Format
Identify Current Skill Level
Employee Questionnaires on computer skill level
Catergorize Staff based on Skill Computer Literacy skill Level
Training Assessment
Training Timing
Documentation Design
Redesign Workflows
Initial Budget
The initial budget for this project is $3,065,000 with a 5-year investment of $18,000,000
Software and licensing = $1,000,000 Hardware = $1,000,000 Implementation= $1,000,000 Training= $65,000
Category
Questions Requiring Vendor Responses How long in business, products offered, strength of website and product offering Number of resources devoted to R&D; recent successful rollouts of R&D activities Strength of positive referrals; why terminated clients left the vendor Company Details Scoring Ranking Total Overall strength of vendor's financial metrics; profitability ratios; leverage, liquity and turnover ratios
Company Details
4 Vendor Financials
Financial Analysis
5 Hardware Requirements 6
Vendor Financials Scoring Ranking Total Strenght of operating system the vendor runs on; ability to run on other operating systems Is purchase of vendor hardware required?
EMR Modular
Is the vendor EMR modular? How many modules come with the basic version?
Hardware Requirements Scoring Ranking Total Can EMR support: Dictation to handheld, using Voice Recognition , Software such as Dragon Naturally Speaking, or dictaphone for later transcription; tablet PCs; CCRs; incoming scans and faxes and technology to support such fuctions
2.00
5.00 1.00
Handheld Devices
Handle real-time and sync; new patient information entered into handheld and ability to sync with EMR; handle billing functions? Does EMR have scheduling module? If not, does it internface with the commonly available products and at what cost? Can system integrate with lab HL7 or other standard, and at what cost Can reports and or images be imported directly and real time from radiology Does the system have integrated billing, or an interface to billing software
2.00
Input Devices
10
Scheduling Module
1.00
11 12 13
HIPAA Privacy and Security Compliant Audit trail of all activity and report unauthorized attempts at access Industry standard electronic signatures & al revisions to a record are electronically signed time-stamped and original entry viewable. Inactivity Time-out functions Security Issues Scoring Ranking Total Supports multi-specialty, or is easily customizable by user for specialty. Support simultaneous users of same patient record with appropriate alert Tracks patient in office from check-in to check out; logging of phone messages in chart; generate patient super bills End-User Interface Scoring Ranking Total List conforms to standard vocbulary MEDCIN/SNOMED Does system maintain active & inactive problem list; software will automatically check problem list against NCD and insurance requirements? Vendor updates CPT and ICD9 codes when carriers make changes, and the cost of this is known upfront; intelligent real-time ICD and CPT code assignment at end of encounter; suggest alternative ICD9 codees and or CPT based on historical data from insurance plan
16 Electronic Signatures
17 Time-Out 18 Specialty Interface 19 Simulateous users interface End-User Interface 20 Patient Logs
23 Codes
2.00
Clinical Objectives
24 Templates
Support automated and easily customizable disease standard H&P templates; can reuse last visit template for subsequent encounter
2.00
25 Patient/Physician Encounter
Can nursing notes be automatically entered into physician encounter note; standard customizable patient handouts; user add messages to other users in chart; user view entire chart from remote location; transcribed notes be entered in chart; create a to-do list in chart and progress notes support pick-lists?
2.00
Clinical Objectives Scoring Ranking Total Track outstanding tests and flag abnormal labs, and have an inbox to place unsigned notes oustanding tests Does the system have the ability to search entire patient database by diagnosis, by medication or other attribute?
10.00 4.00
27 Database Search
4.00
28 Medication List
Long term; active and inactive; Dced & reason; per episode meds; allergy checking Real-time formulary check of insurance plan; frequent updates to formluary at reasonable predetermined fee; can physician customize a frequently used list of medications by disease condition which takes into account formulary?
2.00 2.00
+
Medications
29 Formulary Check
Recording reason for discontinued medication and displaying medication history and last refills How long does it take to write a prescription? Can system audit prescribing patterns? Can system track prescription renewals? Can system print custom admission orders based on disease and patient medications? Medications Scoring Ranking Total What is the cost of the base system? Describe the typical implementation fees for a company of our size What is the cost of annual support services, including maintenance Identify the costs associated with your hosting services Identify any other costs associated with your proposal All pricing information should reflect a multi-year cost. Fees: License, Installation, Maintenance Scoring Ranking Total Overview of process that will be used to implement the system What resources will be provided for implementation
2.00 2.00 2.00 2.00 12.00 2.00 2.00 2.00 2.00 2.00 2.00 12.00 5.00 3.00 3.00 2.00 13.00 3.00 3.00 1.00 2.00 3.00
34 License Fees 35 Implementation Services 36 Software Support Services Fees: License, Installation, 37 Hosting Servicees Maintenance 38 Other Costs 39 Pricing Structure
Implementation Support 42 Communication & Manage communication and training during the implementation; use of project manager Training 43 Integration of How is legacy data integrated into the system? Ability of your products to integrate with legacy system? Legacy Systems Implementation Support Scoring Ranking Total 44 Technical Support Technical support options and hours of operation; describe the documented support process; online support? 45 Product Documentation 46 Feedback Standard service level agreement and product documentation provided? Ensure feedback from group? User group conference
Product Upgrades How are product updates handled? 47 Training Procedures Describe the training procedures for your software. Please identify classes offered, class locations and any other relevant information
Training and Ongoing Support Scoring Ranking Total Can the system generate reports such as incomplete charts, unsigned notes, labs not back after predetermined period, patient missing predetermined follow-up visits, missing level of visit, or visit generating denials?
12.00 3.00
Summary
This business plan attempts to summarize all of the pre-work the Steering Committee conducted in order to prepare for the EMR assessment and deployment.
While we believe we have considered all necessary items of an EMR deployment, such as the project objectives, roles and responsibilities, current and required inventory, training and educational requirements, budget and ROI, return on quality of care, and MMH feedback, along with all the necessary requirements outlined in the RFI, we are open to suggestion and refinement.